{include file="member.header.html"}
{include file="title.html"}
{include file=member.submenu.html}


<script type="text/javascript">
    $(function() {
        $('#integral_goods_form').validate({
            errorPlacement: function(error, element) {
                $(element).after(error);
            },
            rules: {
                my_num: {
                    required: true,
                    digits: true
                },
                my_name: {
                    required: true
                },
                my_address: {
                    required: true
                },
                my_mobile: {
                    required: true,
                    minlength: 6,
                    checkTel: true
                }
            },
            messages: {
                my_num: {
                    required: '{$lang.my_num_required}',
                    digits: '{$lang.number_only}'
                },
                my_name: {
                    required: '{$lang.my_name_required}'
                },
                my_address: {
                    required: '{$lang.my_address_required}'
                },
                my_mobile: {
                    required: '{$lang.my_mobile_required}',
                    minlength: '{$lang.my_mobile_error}',
                    checkTel: '{$lang.my_mobile_error}'
                }
            }
        });
    });
</script>
<form method="post" id="integral_goods_form">
    <ul class="form_content">
        <li>
            <h3>{$lang.goods_name}</h3>
            <p>{$integral_goods.goods_name|escape}</p>
            <p></p>
        </li>
        <li>
            <h3>{$lang.change_num}</h3>
            <p><input type="text" class="text" name="my_num" id="my_num"/></p>
            <p></p>
        </li>
        <li>
            <h3>{$lang.receive_name}</h3>
            <p><input type="text" class="text" name="my_name" id="my_name"/></p>
            <p></p>
        </li>
        <li>
            <h3>{$lang.receive_address}</h3>
            <p><input type="text" class="text" name="my_address" id="my_address"/></p>
            <p></p>
        </li>
        <li>
            <h3>{$lang.contact_tel}</h3>
            <p><input type="text" class="text" name="my_mobile" id="my_mobile"/></p>
            <p></p>
        </li>
        <li>
            <h3>{$lang.remark}</h3>
            <p><textarea name="my_remark" cols="30" rows="4"></textarea></p>
            <p></p>
        </li>
        <li>
            <input class="red_btn" type="submit" value="{$lang.submit}" />
        </li>
    </ul>
</form>
{include file="footer.html"}